Who should be first in line for a life-saving kidney transplant? Should the victim of a terrorist attack take precedent over the terrorist when it comes to receiving medical treatment?

These were two of the questions discussed at Bioethics: The Catch-22 in Medicine and Healthcare, part of Hadassah’s National Business Meeting & Symposium held at the Sheraton Inner Harbor July 30-31. The event was fittingly set in Baltimore, the birthplace of Hadassah founder Henrietta Szold.

Hadassah has been a powerful force in the field of medicine since its founding, when Szold, a fervent Zionist, first sent nurses to Palestine to provide treatment and nutritional support in 1913. Soon after, Hadassah sent an entire medical team to Palestine to provide health care for all those who suffered. This team became the foundation of Israel’s medical system, eventually leading to the two Hadassah-owned medical centers, Hadassah Hospital in Ein Kerem and Hadassah Hospital in Mount Scopus. Today, Hadassah medical centers provide some of the most cutting-edge research and treatment in the world.

On hand to discuss their diverse perspectives were Dr. Jeffrey Kahn, the Ryda Hecht Levi professor of bioethics and public policy and deputy director for policy and
administration at the Johns Hopkins Berman Institute of Bioethics, Dr. Josh Schroeder, Hadassah Medical Organization orthopedic surgeon and spine fellow at the Hospital for Special Surgery in New York City, and Rabbi Avram Reisner, a leading voice on biomedical ethics for the Conservative movement and rabbi at Chevrei Tzedek Synagogue in Baltimore. Before the panelists spoke to the ethical questions that were posed to them, Hadassah members, who had discussed the questions in working groups prior to the program, shared their conclusions.

Below are some of the more interesting questions, answers and ambiguities shared by panelists.

Is it ethical to purchase organs from a poverty-stricken but willing donor?
Rabbi Reisner stressed that the perspective of the Conservative movement is that organ donation is strongly encouraged. He noted, however, that the buying and selling of organs is more complicated, since there is a possibility that the person who sells the organ may be coerced into doing something potentially dangerous or not in his or her best interest. Nevertheless, many believe that, regardless of the circumstances, the saving of a life is paramount and a mitzvah.

Dr. Schroeder discussed the fact that organ donation in developed countries is typically a safe practice, and he noted that Iran is currently the only country where the selling of solid organs such as hearts, livers and kidneys is legal.

“The bottom line: If selling an organ would truly compensate and not hurt the donor, I would do that to help someone,” he said.

What if a 13-year-old girl is diagnosed with a sexually transmitted disease and asks that her parents won’t be informed?
Rabbi Reisner and Drs. Kahn and Schroeder all felt strongly that the question of whether the girl had been sexually abused needed to be addressed before a decision could be made. Since Jewish law sees a 13-year-old who is post-bat mitzvah as an emancipated adult, Rabbi Reisner acknowledged that the girl has a right to privacy. Yet, he stressed that unless involving the parents would cause her harm, it might be more realistic for the parents, who are likely the holders of her medical insurance, to be informed.

Dr. Kahn stressed that in the case of STDs, medical professionals are obligated to report the case to the health department.

“Privacy rights must be balanced with respect for her parents, her medical status and the public-health interest. Sometimes, public health trumps individual rights,” he said.

In the case of pandemic flu, if there is not enough vaccine, who should receive it?
Dr. Kahn said this should depend upon the strain of flu itself.

“Some flus are more likely to strike the old and those with compromised immune systems, and others attack younger, healthier people. Whoever is more vulnerable should receive it. On the other hand, if the most vulnerable are kids, it does no good for them to receive it if there will be no one alive to care for them,” he said.

In that case, he noted, first responders should receive the vaccine.

The situation is somewhat simpler in Jewish law.

“It’s first come, first serve,” said the rabbi.

Yet, he acknowledged the situation is more complicated when many people are in need at the same time.

“In Jewish law, we don’t discriminate because of age. No one living person has preference over another,” he said.

Dr. Schroeder said that within the next 10 to 30 years, resources will be more limited, and treatment will be given less frequently. He and Dr. Kahn both stressed that shortly this question will not be rhetorical.

“Society will need to ask this question. Pandemics are just around the corner,” said Dr. Schroeder. “We need to think not only of the infected person, but also of the circle around him, and the next circle and the next. … How do we stop it from spreading? Who needs to be treated first to prevent the pandemic?”

Should a terrorist be treated as readily as his or her victim?
“Health care is a human right and giving care is a human obligation,” said Rabbi Reisner.

Since he practices in Israel, Dr. Schroeder has actually experienced this situation on several occasions.

“We put our emotions aside. The person who needs care most will go to the operating room first. Luckily, there is enough care for everyone.”